Charles Bernstein, MD, on the Changing Demographic of IBD

Dr Bernstein reviews his talk at the AIBD annual meeting in Orlando on the incidence of IBD in newly industrialized countries and developing countries and discusses the impact of dietary factors on IBD development.

Charles Bernstein, MD, is a professor of medicine and serves as the director of the IBD clinical and research center at the University of Manitoba in Winnipeg, Canada.

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Transcript:

I'm Dr Charles Bernstein, a distinguished professor of medicine at the University of Manitoba and the director of the University of Manitoba Inflammatory Bowel Disease Clinical and research center. I'm here at the Advances in IBD meeting in Orlando, Florida. I spoke about the changing demographic of IBD.

This is an important topic because IBD has become a universal disease really in all corners of the Earth. Although we don't have data from all corners of the Earth, we're gathering emerging data from all corners of the Earth, and we know that clinicians are caring for IBD in disparate places in Africa and Asia, not just in the west.

In fact, the incidence is rising in Asia, particularly in China and India to the point that in the not too distant future because of the huge denominator in China and India, there will be more persons with IBD in those countries than there will be in the West. In terms of the changing  incidence rate, in fact, it is fairly flat in countries where it can be monitored like in our country of Canada or in Scandinavia where there are excellent administrative health data where one can track population based data.

The age groups where the incidence is rising—in fact, this was a study shown by Eric Benchimol, led a consortium of Canadian provinces, including my own, show that the incidence rate is fairly flat across the age spectrum, except in very early onset IBD, that is children under the age of 5 have an increasing incidence rate. So what that will translate to is that we will see more older children and ultimately young adults with IBD.

And because persons with IBD don't necessarily have a higher mortality rate, we're gonna continue to accumulate cases such that the prevalence of IBD everywhere, including in the West, is rising. And our population that we're gonna be managing in our clinics over the next several years It's really going to be booming. Gil Kaplan's group at the University of Calgary with Stephanie Coward as the first author published a paper showing that by 2030 in Canada, 1% of the population have IBD. We know that the elderly are an important group of IBD, not only because they present with new diagnosis of IBD, but also because as people are living to ripe old ages in their seventies and eighties, they have IBD that they may have had for several years.

And the challenge in managing elderly patients is many fold. There are many different, aspects to managing an older person that may be different than a younger person. Least of which is their frailty or potential cognitive impairment, but also their comorbidities and polypharmacy that may impact on, how we treat patients. What's really quite striking though is that when we plan our treatment of patients who are elderly, we are really extrapolating data from clinical trials in younger patients. It's remarkable how few elderly patients, that is people either over 55 or 65 depending on the definition in anyone study make it into the clinical trials. It's in single digits. In some instances, 2, 3, or 5%. And so when we're looking for answers as to how to treat elderly patients, we don't necessarily glean them from clinical trials the way we might think we do, or we may like to.

Finally, one aspect of the changing demographic is, of course, immigrant populations and bringing with immigrant populations are poor populations. And we and others, including the group at the University of Miami, have looked at socioeconomic factors that impact on IBD. And we've shown that persons with low socioeconomic status, even when they have the same access to health care, for instance, in a country like Canada, they simply do worse. It's not because they're getting treated less. We've shown that they have the same rates of using biologic therapy, the curing therapy, 5 HSA therapy. But they end up getting hospitalized more. They end up in the ICU more, and they actually have a higher mortality rate.

So it behooves us to make special efforts some patients of lower socioeconomic status and how we treat them. And probably, while we've all considered having psychologists and dietitians as part of our team managing patients with IBD, what we also need is a social worker.

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